DESCRIPTION: This application proposes an evaluation of clinical preventive dental services in a Medicaid population to reduce caries in young children. At the center of interest is the five-year Washington State Medicaid Dental Prevention Demonstration Project which began in Spokane County, Washington, on February 1, 1995. The project provides multiple applications of fluoride varnish sealants and family oral health education for Medicaid-enrolled children from birth to 5 years old from minority and immigrant families with low incomes. These children are at high risk for early childhood dental caries. The project also involves training dentists in child management and preventive dentistry, with special attention on how to work with young children and families from low incomes. Medicaid dental reimbursement will be provided at a higher reimbursement level, at the seventy-fifth percentile instead of the forty-fifth percentile for the trained dentists. The Spokane District Health Department is to provide case managers for the high risk families. The proposed investigation is based on a non-equivalent control group design. Spokane County will be the intervention county. Pierce County, which is similar to Spokane County in the percent of population drinking fluoridated water, as well as minority populations, will be the control county. Spokane was chosen because it is a large county with both rural and urban poor and because access to water fluoridation is low. The data to be analyzed will come from several sources. Cost and utilization data will come from the state's Medicaid Management Information System (MMIS). Other information will be gleaned from oral exams administered in both counties and health questionnaires administered in Spokane County. The latter will be used to develop models of dental utilization and program participation. The project will first assess differences in utilization between the two counties using the MMIS database. It will also develop a model of the factors that influence utilization using data from Spokane County, as well as a model to determine the effect of improved access (early utilization) on the attitudes/beliefs of parents in Spokane County, comparing program vs. non-program participants. The project will then assess the impact of the program on the incidence of dental caries by comparing oral health data for children in the two counties. Finally, the project will conduct two cost comparisons, one for program and non-program participants in Spokane County, and one for Spokane vs. Pierce County.